MEDICARE: AUGUSTUS BUSUMBRU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1588421317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUGUSTUS BUSUMBRU

Provider Business Mailing Address
First Line	:	16543 OASIS GLADE DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-1222
Country	:	US
Telephone Number	:	713-201-8108
Fax Number	:

Provider Business Practice Location Address
First Line	:	16543 OASIS GLADE DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-1222
Country	:	US
Telephone Number	:	713-201-8108
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2024
Last Update Date	:	02/28/2024

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Directions to “ AUGUSTUS BUSUMBRU ” Practice Location

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